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Urgent multi-branch endovascular graft rescues
thoracoabdominal aortic ruptureafter successful open surgical repair
Nyityasmono Tri Nugroho*, Monika Herten, Giovanni Torsello, Giuseppe Panuccio
Department of Vascular Surgery, Uniklinikum Münster (UKM), Germany
*RSCM-Universitas Indonesia, Jakarta
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Disclosure
Speaker name:
Nugroho, Nyityasmono Tri
I have the following potential conflicts of interest to report:
Consulting
Employment in industry
Stockholder of a healthcare company
Owner of a healthcare company
Other(s)
I do not have any potential conflict of interest
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• Rupture TAAA close toLRA
57 y.o male
Ruptured Type IV TAAA,
CKD st III,
PAD
Rupture of the type IV TAAARupture site
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After Open TAAA
Celiac Trunk
SMA
LRA (throughbranch graft)
Creates a narrowupright angle
RRA Anastomosis
Lost of RRA
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• During dialysis, acute Hb drop
• CT scan new rupture, active hematoma
• Transferred to us directlyin OT
Two monthslater
• Patient could bedischarged
• In hemodialysis
Fifteen dayslater
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Re-rupture
Rupture site sutureleakage
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Urgent Endovascular Treatment was performed
Off the ShelfT-BRANCHendograft
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Visceral VesselsCeliac Trunk
SMA
LRA
LRA creates cranialorientation
Amplatzer 10 mm
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Post t-Branch
Patency CT and SMA
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multi-branchendograft (ZTEG
2 PT)
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t-Branch Endograft and Accessories
Thoracic Aorta Endograft ZTEG 2 PT
Valiant EndograftVAMC
Celiac Trunk (Advanta 8x59 and
8x38)
SMA(Viabahn 13x10 &
Palmatz 8x29)RRA & LRA (closed
with Advanta 6x59 & Amplatzer 10 mm)
Discharge 10 Days after, @7Months Survival
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Conclusions
• The endovascular treatment represents an effective solution also in urgent setting
• t-Branch provides wide range in avaibility1
• The orientation of the visceral vesselrepresents main limitation
1Bisdas T, Austermann M. The Zenith t-Branch Endograft: What have we learned so far?. 2016. Journal of Endovascular Therapy.
Vol. 23 (I) 216-219
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Conclusions
• No evidence concerning the treatment choice is available
• Algorithm needs to be established considering the center and operator experiences
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Urgent multi-branch endovascular graft rescues
thoracoabdominal aortic ruptureafter successful open surgical repair
Nyityasmono Tri Nugroho*, Monika Herten, Giovanni Torsello, Giuseppe Panuccio
Department of Vascular Surgery, Uniklinikum Münster (UKM), Germany
*RSCM-Universitas Indonesia, Jakarta